Dr. William Frishman from the New York Medical College/Westchester Medical Center, Valhalla, NY moderated the topic "Critique of Randomized Controlled Trials Comparing Percutaneous Coronary Intervention with Medical Therapy in Patients with Stable Angina" with Drs. Jeffrey Borer from the State University of New York Downstate Medical Center, Brooklyn, NY, Joseph Alpert from the University of Arizona in Tucson, Tucson, AZ, and Arthur Fass from the New York Medical College/Westchester Medical Center, Valhalla, NY and New York Medical College/Phelps Memorial Hospital, Sleepy Hollow, NY.

The discussion focused primarily on:

(1) Clinical trials and practical experiences dealing with patients who have stable angina;

(2) the importance of individualizing therapy based on a patient's risk factors;

(3) whether or not the use of invasive and aggressive approaches lead to minimizing sudden death;

(4) the use of diagnostic tests used to evaluate patients with classic anginal symptoms

(5) the use of coronary bypass grafting compared to angioplasty;

(6) the use of ACE inhibitors, aspirin, beta-blockers, calcium channel blockers and nitrates for patients with stable angina;

"Patients and physicians may be attracted to a less invasive angioplasty and stenting approach for suitable coronary lesions, however, there are issues with the recommended anticoagulation regimens, which could include two antiplatelet drugs and another anticoagulant if the patient is in atrial fibrillation."~ William Frishman, MD

"I believe that in a patient who's being treated maximally with antianginal therapy, and who is unhappy with the angina, that there is probably a very good rationale for applying angioplasty."~ Jeffrey Borer, MD

"The problem in making decisions for an individual patient based on the randomized trials is that randomized trial patients are often very different from the patients you're dealing with because, as we all know, the patients are highly selected for the randomized trial."~ Joseph Alpert, MD

"We would all be aggressive in trying to prevent sudden death in coronary events. Question is, does the invasive intervention with angioplasty and stenting accomplish that purpose? I think this is one of the issues that we need to think about."~ ~Arthur Fass, MD